COVID-19 Causes Acute Transverse Myelitis in Patients

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MRI showing Transverse Myelitis Source: Frank Gaillard - http://radiopaedia.org/cases/transversemyelitis

Doctors are reporting increasing cases of a rare spinal cord inflammation, called acute transverse myelitis, among COVID-19 patients.

To date, more than 3 million lives have been lost to COVID-19. As rich nations continue with their vaccination programs, countries such as India, Pakistan, and Brazil are left dealing with a devastating outbreak. However, the increasing deaths and hoarding of vaccines by the rich are not the worst things about the pandemic. It is the fact that we are not yet any closer to understanding the mysterious SARS-CoV-2. We know the virus can cause a wide range of symptoms, along with severe neurological effects. But the exact mechanism remains unclear. Moreover, researchers have now identified an even more rare manifestation of the disease. According to a recent study, acute transverse myelitis has become an ‘unexpectedly frequent’ neurological complication of COVID-19.

Acute Transverse Myelitis is a rare neurological condition that results from spinal cord inflammation. It has an estimated incidence of between 1.34 and 4.6 cases per million people each year. Symptoms include limb weakness, pain in back or neck, tingling or numbness in the feet and arms, and difficulty urinating. Although the mechanism is unknown, it is considered an autoimmune reaction since it often follows a viral infection or vaccination.

Researchers at Houston Methodist Hospital reported the case of a patient from Panama who developed acute transverse myelitis after a COVID-19 infection. Additionally, they also conducted a comprehensive review of COVID-19 associated transverse myelitis.

43 Patients from Across 21 Countries

The results revealed a total of 43 cases across 21 countries; reported between March 2020 to January 2021. Moreover, 3 of the cases occurred among participants of the Oxford-AstraZeneca vaccine trials. Based on the total of 86 million COVID-19 cases on 5th January 2021, researchers estimate the global incidence of COVID-19 associated acute transverse myelitis as 0.5 per million.

The patients ranged in age from 21 to 73 years. Although majority of the cases occurred among those older than 44 years, 14 cases happened in young adults and three in kids. All the patients presented with typical features of the disease; paralysis, loss of sensation, sphincter dysfunction, and spinal cord lesions on MRI scans.

The exact cause of this neurological complication remains unclear. However, the authors of the study suggest coronavirus antigens may play a role in the development of the disease.

The pathogenesis of ATM [acute transverse myelitis] remains unknown, but it is conceivable that SARS-CoV-2 antigens – perhaps also present in the AZD1222 COVID-19 vaccine or its chimpanzee adenovirus adjuvant – may induce immune mechanisms leading to the myelitis

study authors

Reference:

Román, Gustavo C., et al. “Acute Transverse Myelitis (ATM):Clinical Review of 43 Patients With COVID-19-Associated ATM and 3 Post-Vaccination ATM Serious Adverse Events With the ChAdOx1 NCoV-19 Vaccine (AZD1222).” Frontiers in Immunology, vol. 12, 2021, doi:10.3389/fimmu.2021.653786.

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